By Dr Andre Clarke

What does it mean to have an avulsed tooth? The terminology sounds very complicated, but it is simply when an individual accidentally has a tooth knocked out.

One popular dictionary’s definition of the word avulse is “to tear or pull away or pluck off”.

This description is most appropriate when it is used in reference to teeth.

If you analyse the anatomy of a tooth in its socket (the hollow or opening into which the tooth sits), you will quickly realise that a tooth remains in its socket because of its cementum and ligaments.

The cementum is in essence “cement” and the ligaments are in essence “fasteners”; together they keep the tooth from falling out of the gum. Of note, the aforementioned dictionary’s definition implies in its tone that force is involved in the “tearing”, “pulling” or “plucking” process.

When the bonds between the affected tooth and the periodontal ligaments within the cradling socket are broken, the now “avulsed” tooth starts to die. The avulsion results in the cessation of oxygen and nutrients to the nerve/pulp of the tooth and the eventual death of the nerve/pulp.

So the very astute question is, “If the nerve that kept the tooth alive before it was knocked out, will eventually die, why attempt any heroics to reimplant (put back into the socket) the avulsed tooth?”

The answer is simple, it is to keep the periodontal ligaments alive.

The primary goal of rapid reimplantation is to preserve the periodontal ligaments (fasteners) and not to keep the tooth alive.

It is generally accepted that most avulsed teeth will eventually require root canal therapy (a dental procedure that replaces a tooth's damaged or infected nerve/pulp with a filling material).

Therefore, the principal aim has to be to keep the periodontal ligaments alive. When this occurs, the tooth can remain in the mouth and aid in maintaining the facial profile; assisting with eating and enhancing speech. Also of note, how quickly the tooth is reimplanted can vary the survival rate of the periodontal ligaments. The sooner the tooth is reimplanted, the better the chance of survival.

If after reimplantation and the root’s (part of tooth that sits under the gum) surface fuses to the surrounding bone or dissolves away, it is an indication of a failed reattachment process.

In the unfortunate event that you or someone you care about has a tooth knocked out, there are some things that need to be done immediately.

1. You should verify that the entire tooth is knocked from the socket and if so, put the tooth back into socket immediately. If the tooth falls on an unclean and contaminated surface, rinse it off gently with water before reimplanting. The water can be government, well or bottled water. Ensure it is clean water.

2. Hold the tooth by the top (crown) part and not the bottom (root) part. This is to decrease the chance of your fingers destroying any

ligaments.

1. Once the tooth is back in the socket, bite together and go to the closest dentist immediately. The sooner you arrive at any dental

professional’s office, the better. Please aim to arrive at the professional’s office in less than an hour. Success rates for reimplantations significantly decrease after an hour of the incident.

1. If you are unable to adequately perform suggestions 1 and 2, place the tooth in a solution and go immediately to a dental office. The solutions of choice in the order of preference are Hank's Balanced Salt Solution, which should be kept in stock by most schools, churches and community centers; milk; salt water; saliva (spit), and plain water. Some dental professionals also suggest that transportation in foil paper is acceptable.

When you have done your part, the dentist will then do his part, which will most likely include advice to get a tetanus vaccination, against the bacterium that causes tetanus. The bacterium is usually found in contaminated soil. It would therefore be logical to receive the vaccine if the avulsed tooth falls on possibly contaminated soil. After the advice is given, and there is no socket fracture (break) or tooth fracture, the dentist will clean the tooth and treat it with fluoride (if necessary). The dentist’s actions depend on the elapse of time, starting from the time of tooth avulsion. When the tooth is ready for reimplantation, it will be inserted into the socket, and wired and/or cemented to neighbouring strong teeth.

After the procedure, the dentist will then discuss the rate of success of reimplantation and the need for future root canal therapy. The at length discussion usually takes place after the reimplantation, so that the time with the tooth out of the socket is reduced. Of interest, a reimplanted tooth with or without a completed root canal therapy should be followed up for five years, to ensure continued ligament attachment.

If your tooth is knocked out, please go to a dental healthcare professional within the hour. It will serve you well in the future.

Keeping your mouth alive now will ensure an intact smile for the future.